Republican alternatives?

[stpioc]

Repeal they want, but what will replace it? Well..

To protect consumers and slow healthcare cost growth, Republicans Donald Trump, Ted Cruz and Marco Rubio have united behind two proposals. The first is to let insurers offer policies across state lines. That's a solution in search of a problem, however, because health insurance is by its very nature a local product, not a national one. To serve consumers in Los Angeles, insurers have to line up a network of doctors in Los Angeles; it does them no good to offer Angelenos access to a network in Sioux City, no matter how low the cost. Meanwhile, hospital and physician groups are consolidating, giving them more power to dictate prices to whatever insurers happen to serve their region. That's a problem no candidate is discussing. 

The second GOP idea is to lower the cost of high-deductible plans, which encourage consumers to become smarter shoppers for healthcare services. That may be a good idea, but it's no panacea. Not only do consumers often need healthcare on an urgent basis — one doesn't shop around for an ambulance service — but they lack the sort of comparison-shopping tools they rely on for most every other good they buy. Medical professionals are slowly developing ways to measure the quality of a doctor, hospital or treatment, but those efforts are in their infancy.

Campaign 2016: GOP plans to repeal Obamacare won't bring the change you're hoping for - LA Times

We'll keep you posted..

[stpioc]

Do these alternatives amount to much? Probably not:

Trumpcare erects a massive barrier to coverage: It allows insurers to deny coverage to sick people. This is pretty typical of Republican Obamacare replacement plans; only one of eight plans that McDonough analyzed required insurers to offer coverage to all individuals, even if they were especially sick.

Trumpcare would also allow the return of underwriting, where insurers can charge some subscribers more because they're especially sick. Under Trumpcare, a cancer patient could, theoretically, deduct his or her premium, which could make coverage more affordable — but that cancer patient might not be able to get coverage or have the cash to pay for it in the first place. There are at least 60 million Americans with preexisting conditions. Some of them have coverage under Obamacare. If Trumpcare became law, there's no guarantee they'd get to keep it. It's a pretty big crack to slip through.

Trumpcare, explained - Vox

[stpioc]

There are no ACA alternatives on the right, here is Paul Krugman explaining that once more:

Alternatives to the left do exist. True socialized medicine — an American NHS — would be feasible economically; so would single-payer, in the form of Medicare for all. The reasons we aren’t doing those are political. But on the right, is there a more free-market, more privatized system that could replace the Affordable Care Act without causing the number of uninsured to soar? No, as some of us have tried to explain many times.

Once again: a useful starting point is the problem of people with pre-existing conditions. How can they be offered affordable insurance? You can prohibit insurers from discriminating on the basis of medical history — community rating. But if that’s all you do, only sicker people will sign up; many will wait until they get sick to buy insurance; and so costs will be high due to a bad risk pool. So non-discrimination must be combined with an individual mandate, the requirement that everyone get insurance. But what about people who can’t afford it? There must be subsidies to lower-income families, so that they can.

What you end up with, then, is community rating + individual mandate + subsidies — that is, with Obamacare. There’s nothing arbitrary about it, and you can’t pick and choose from the elements: it’s a three-legged stool that needs all three legs to stand. And it can’t be made cheaper, either — the subsidies are already on the low end, requiring that the allowed policies can involve higher deductibles than they really should.

Economics and Politics by Paul Krugman

[stpioc]

Obamacare, The Unknown Ideal
March 31, 2014, 3:58 pm


No, I haven’t lost my mind — or suddenly become an Ayn Rand disciple. It’s not my ideal; in a better world I’d call for single-payer, and a significant role for the government in directly providing care.

But Ross Douthat, in the course of realistically warning his fellow conservatives that Obamacare doesn’t seem to be collapsing, goes on to tell them that they’re going to have to come up with a serious alternative.

But Obamacare IS the conservative alternative, and not just because it was originally devised at the Heritage Foundation. It’s what a health-care system that does what even conservatives say they want, like making sure that people with preexisting conditions can get coverage, has to look like if it isn’t single-payer.

I don’t really think one more repetition of the logic will convince many people, but here we go again. Suppose you want preexisting conditions covered. Then you have to impose community rating — insurers must offer the same policies to people regardless of medical history. But just doing that causes a death spiral, because people wait until they’re sick to buy insurance. So you also have to have a mandate, requiring healthy people to join the risk pool. And to make buying insurance possible for people with lower incomes, you have to have subsidies.

And what you’ve just defined are the essentials of ObamaRomneyCare. It’s a three-legged stool that needs all three legs. If you want to cover preexisting conditions, you must have the mandate; if you want the mandate, you must have subsidies. If you think there’s some magic market-based solution that obviates the stuff conservatives don’t like while preserving the stuff they like, you’re deluding yourself.

What this means in practice is that any notion that Republicans will go beyond trying to sabotage the law and come up with an alternative is fantasy. Again, Obamacare is the conservative alternative, and you can’t move further right without doing no reform at all.